Coronary artery disease in patients undergoing valve replacement at a tertiary care cardiac centre (original) (raw)
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The Journal of Thoracic and Cardiovascular Surgery, 1990
The influence of coronary artery disease and bypass grafting on sunival after valve replacement for aortic stenosis (1975 to 1986, N = 512) was analyzed. Mean follow-up for 3O-day sunivors was 5.1 years (0.1 to 12.9 years), A total of 205 patients bad coronary angiography performed: 122 did not have coronary artery disease, 55 with coronary artery disease underwent bypass grafting, and 28 with coronary artery disease did not. Early mortality rates «30 days)f5-year cumulative sunivals (standard error) were 4.1%/86% (4%), 3.6%/68% (8%), and 17.9%/51% (13%), respectively (p <O.05/p<0.01~Triple vessel/left main stem disease was more prevalent in patients with coronary disease who underwent bypass grafting (47%) than in those who did not (14%; p < O.~Multivariate analysis revealed that right ventricular failure and omission of bypass grafting in patients with coronary artery disease were independent determinants of early mortality. A Cox regression analysis identified coronary artery disease and aortic valve gradient as determinants of mortality after hospital dismissal, which was not influenced by bypass grafting. On the basis of a coronary artery disease score (positive predictive value for coronary artery disease of 66 %) developed on the patients with angiography, 307 patients without angiography were divided into 234 with a low score and 73 with a high score. Early mortality rates/5-year sunivals (standard error) were 6.4% /86% (2%) and 16.4% /67% (6%), respectively (p < O.OI/p < O.OOI~Autopsy revealed stenotic or occh6ive coronary artery disease
The Thoracic and cardiovascular surgeon, 2014
There is a paucity of data on the impact of smoking status on outcomes after concomitant aortic valve replacement and coronary artery bypass graft (AVR-CABG) surgery. Data obtained prospectively between June 2001 and December 2009 by the Australian and New Zealand Society of Cardiac and Thoracic Surgeons National Cardiac Surgery Database Program were retrospectively analyzed. Demographic and operative data were compared between patients who were nonsmokers, previous smokers, and current smokers using chi-square test and t-test. The independent impact of smoking status on 14 short-term complications and long-term mortality was determined using binary logistic and Cox regression, respectively. Concomitant AVR-CABG surgery was performed in 2,563 patients; smoking status was recorded in 2,558 (99.8%) patients. Of these, 1,052 (41.1%) patients had no previous smoking history, 1,345 (52.6%) patients were previous smokers, and 161 (6.3%) patients were current smokers. The 30-day mortality ...
2009
We assessed the effects of aortic valve pathology type on the long-term outcomes of patients who underwent concomitant aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) surgery. We retrospectively reviewed 150 patients who underwent AVRCABG at our institution between January 1997 and December 2006. We divided patients into aortic stenosis (AS), aortic regurgitation (AR), and mixed-type groups consisting of 98 (65.3%) ,2 0(13.3%) and 32 (21.3%) patients, respectively. The AS group had more female patients, a higher mean angina class, older mean patient age, increased history of previous myocardial infarction (MI), and smaller valve size compared to other groups. No significant differences were observed among groups in the operative mortality for five or ten-year survival rates. Significant early mortality risk factors included cross-clamp and cardiopulmonary bypass (CBP) time, number of blood transfusion units, chronic obstructive pulmonary disease (COPD), int...
Indian Heart Journal, 2013
To determine the prevalence of coronary artery disease in patients undergoing valve surgery at a tertiary care cardiac centre. The medical records of 144 consecutive patients who underwent mitral, aortic or dual (mitral and aortic) valve replacement surgery at the Tabba Heart Institue between January 2006 to December 2008 were retrospectively reviewed. All patients underwent coronary angiogram. Significant coronary artery disease (CAD) is defined as coronary stenosis of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 50%. There were 74 (51.4%) males and 70 (48.6%) females in the study. The mean age was 51.64 +/- 11 years. Of all, 73 (50.7%) underwent mitral valve replacement, 47 (32.6%) had aortic and 24 (16.7%) had dual valve replacement. Out of 144 patients, 99 (68.8%) had &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 50% coronary stenosis and remaining 45 (31.3%) had &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 50% stenosis. In patients who had undergone mitral valve replacement (MVR), significant coronary disease was found in 32.9%, whereas in patients who had undergone aortic valve replacement (AVR) and dual valve replacement (DVR) the prevalence of coronary disease was 31.9% and 25% respectively. Our results suggest that the overall prevalence of coronary artery disease in patients undergoing valve surgery in our population is comparable with prevalence reported in international data.
SJM, 2020
Background: Smoking is a well-recognized risk factor of CAD, angiographic profile and traditional risk factors among smoker patients varies, along with their clinical presentation and outcome. Objective: This study has been conducted to focus on the angiographic profile of smoker patients presenting with CAD and to explore the prevalence of their additional of risk factors. Method: This study has been enrolled among 328 smoker patients with CAD presenting to ER of SSH-cardiac Center/ Erbil from Jan 2017 to March 2020. Results: The study population was composed of 320 males (97.6%) and 8 females (2.4%). The mean age was 39.07+12.3 years, with an age range of 20-75. The results showed that smoker patients with CAD had occlusive CAD (79.3%). The prevalence of most commonly occluded artery was LAD (43.8%) during CoA presenting with AWMI. The prevalence of risk factors was, Hypertension (37.8%), positive family history (40.2%), high levels of LDL (53.7%), Lowered levels of HDL (31.7%), elevated levels of TC (31.7%), elevated levels of TG (29.3%). It was noted that 29.3% were Diabetic, and according to the HbA1c levels, of 34.1% was diabetic, this clarifies that 4.8% of the smoker patients were undiagnosed DM (Newly diagnosed DM). Conclusion: Smoking is associated with the angiographic profile, traditional risk factors and their clinical outcomes. AWMI was mostly observed among smoker patients owing to LAD lesions.
Prognostic Value of CT Coronary Angiography In a Large Population with Known or Suspected CAD
Aim To assess the prognostic relevance of 64-slice computed tomography coronary angiography (CT-CA) and symptoms in diabetics and non-diabetics referred for cardiac evaluation. Methods We followed 210 patients with diabetes type 2 (DM) and 203 non-diabetic patients referred for CT-CA for ruling out coronary artery disease (CAD). Patients were without known history of CAD and were divided into four categories on the basis of symptoms at presentation (none, atypical angina, typical angina and dyspnoea). Clinical end points were major cardiac events (MACE): cardiac-related death, non-fatal myocardial infarction, unstable angina and cardiac revascularizations. Cox proportional hazard models, with and without adjustment for risk factors and multiplicative interaction term (obstructive CAD × DM), were developed to predict outcome. Results DM patients with dyspnoea or who were asymptomatic showed a higher prevalence of obstructive CAD than non-diabetics (p ≤ 0.01). At mean follow-up of 20.4 months, DM patients had worse cardiac event-free survival in comparison with non-DM patients (90% vs. 81%, p=0.02). In multivariate analysis, CT-CA evidence of obstructive CAD (in DM patients: HR: 6.4; 95% CI: 2.3-17.5; p<0.001; in non-DM patients: HR: 7.4; 95% CI: 2.1-26.7; p=0.002) and the presence of typical angina (in DM patients: HR: 2.9; 95% CI: 1.3-6.3; p=0.007; in non-DM patients: HR: 2.7; 95% CI: 1.1-7.1; p=0.03) were independent predictors of MACE in both groups. Furthermore, other independent outcome predictors included dyspnoea (HR: 3.8; 95% CI: 1.7-8.5; p=0.001), the number of segments with any CAD (HR: 1.1; 95% CI: 1.001-1.2; p=0.04) in DM patients and coronary calcium score >100 in non-DM patients (HR: 5.6; 95% CI: 1.4-21.5; p = 0.01). In Cox regression analysis of the overall population, interaction term obstructive CAD × DM resulted in non-significance. Conclusions Among DM patients, dyspnoea carried a high event risk with a MACE rate four times higher. CT-CA findings were strongly predictive of outcome and proved valuable for further risk stratification.
Impact of smoking in patients undergoing transcatheter aortic valve replacement
Annals of translational medicine, 2018
The paradox that smokers have better clinical outcomes in cardiovascular diseases remains controversial. No literature exists studying impact of smoking on outcomes following transcatheter aortic valve replacement (TAVR). We performed an electronic search of the 2011-2012 National Inpatient Sample (NIS) database to identify all TAVR hospitalizations. Outcomes were measured comparing smokers to non-smokers. A total of 8,345 TAVR hospitalizations were identified with 24% being smokers. Compared to non-smokers, smokers were younger (80.4±8.8 81.4±9.2 years, P<0.001), were more often men (63.6% 47.8%, P<0.001), and had a higher disease burden. Despite a higher disease burden, smokers had lower post procedure stroke (2.8% 3.1%), hemorrhage events (28.2% 32.0%, P<0.05) and lower all cause in-hospital mortality (1.2% 5.7%, adjusted odds ratio 0.21, 95% CI: 0.13-0.32, P<0.001) compared to non-smokers. Despite having a higher cardiovascular disease burden, smokers had better outc...